DIY ≠ Change Agent – But Right Now, It’s All I’ve Got

My medical school always made a big fuss about training us to be “Change Agents” – so much so that I guess it sometimes became a joke to us. The idea was that we would be active role players in whichever environments we found ourselves instead of sitting back and complaining, but it often seemed like an unrealistic expectation, given some of the challenges we face in public healthcare.

As I was reflecting on the past three months, I caught myself thinking: have I been a Change Agent? (And then I automatically almost scoffed at myself. I like the idea of being an agent of change but the term is so over-used that I have come to hate it.)

I’m not unrealistic. I’m quite aware of my limitations as an intern. The bottom of the bottom of the feeding chart. I can hardly get a nursing student to pay any attention to me and I have less political clout than the babies we deliver (at least if something bad happens to them, people have meetings about it). So I don’t think I should have been able to do something BIG during this time.

I have had some ideas, but to be honest, I’ve done less of inspiring change and more of just doing it my own damn self.

It has been for my own safety and sanity, really. When I find sharps disposal bins placed in dangerous positions, I put them in less dangerous positions. The next day I’ll inevitably find them back in their original spot, and I rearrange them again. The Change Agent thing to do would have been to talk to the nurses about this, but I’m dealing with some very political nurses who are very certain that they know better than the intern who looks like she still belongs in high school. The other option is to get Occupational Health to look into the matter, I suppose.

In the beginning, I nagged nurses to find me the right size gloves. Inevitably they would take hours to find them, and then bring me gloves half a size too big and past their expiry dates (did you know that gloves had expiry dates? Now you do.) I got so tired of this that I went scouting through the hospital stores myself and managed to find the RIGHT size gloves. Now I just keep my own stash. But it seems some of the scrub nurses have noticed and all of the sudden they stock the correct gloves for me. That’s sort of change, although it took a while.

The truth is, you have to pick your battles. I’d like to get through internship without being an emotional wreck. And it does wreck me when I ask someone to find something (like, say, 5ml syringes) and they respond by clicking their tongue and mumbling. I shouldn’t have to beg people to do their jobs, but arguing with them isn’t going to bring me anywhere. So I do what I can to expedite speedy service delivery even if it does mean that I do things that I technically shouldn’t have to do.

And I hope that some of the people in our healthcare teams will pick up on that.

On a positive note, I tweeted a while ago about a concerning trend I was seeing with IV metronidazole giving-sets. I heard last night that it had reached the Medicines Control Council (thanks to a pharmacist friend of mine), so something real might actually come from that. We’ll see.

I would say doing it yourself is being an agent of change. While “activism” generally more visibly brings change, setting an example often does it more effectively, if more subtly. You’re not seeing the effect of the things you do, but other people do see. Your actions make ripples, and each time you move that bin it reinforces the ripples from the previous time you did it, until eventually it causes the nurse or orderly who leaves it there to place it in the correct location themselves.

Same goes for the way you care for patients, the way you do the things at work that are your job, and the things that aren’t. If you make ripples long enough, they’ll eventually become waves. Don’t get discouraged. Keep making ripples.

Your smallest action can have an impact. Remember the Butterfly effect? An example I like to use to tell others is… What if you walked to a bridge and just stood there looking at the water, there is only one other person there, who like you, is just looking into the water… then the person walks away… What if, just what if… Because you were there… He didn’t jump? You will never know, he will never tell, but you just saved a life… simply by being there. And the ripples from that action, will spread wide and far. Hang in there!!! The World will change and reflect back your goodness to you.

You have no idea how much you’re preparing me for my own internship. We face many of the same problems, with staff being kind of ‘lax’ about their jobs. Keep on doing the right thing; you’re getting lots of good thoughts from halfway across the globe 🙂

I would like to echo two awesome bits of wisdom I love. One from you – pick your battles, and one from your friends – little things matter. Gotta remember these, they will see you through a lot.

Another idea that occurs to me is sometimes a shift happens only after some focused interaction, and this takes time and energy that you most likely do not have. I am thinking of that sharps bin. It could finally land where you want it and stay there, or it could go back and fourth, and possibly lead to an ever increasing irritation and/or power struggle that benefits no one.

To make the change stick may take each side understanding the concern of the other. What is it about the placement makes it unsafe? What is it about the placement makes it preferable? Is there an option that serves both concerns? Maybe that would just take a little conversation or maybe it would take a whole big old thing. But either way it would probably take some time and energy that realistically isn’t available to you.

My guess is you’re exhausted and really do not have the resources to take on any extra battles, even little ones. Kind of brings us back to those wisdoms of pick your battles and small changes do matter.

In the meantime I hope you take good care of yourself and keep writing! You are much more than the bottom of the bottom for so many of us, are doing amazing work as a talented, caring, and thoughtful intern, and we love you. Hang in there Mariechen, you really are quite wonderful!!
-Nancy

Thanks for the huge encouragement, Nancy! You’re right. Even little bits of additional time and energy are hard to come by at this stage (but at the same time, being frustrated takes a lot of energy… so maybe I need to facilitate conversation regardless). But I do think taking care of myself should take priority in this situation because I don’t want to become a burnt out provider. Thank you again for your wonderful support!